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KMID : 0377619640060060657
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Korean Jungang Medical Journal
1964 Volume.6 No. 6 p.657 ~ p.668
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Pathologic Study of the Typhoid Lesion in the Ileum with Perforation.
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Abstract
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Investigation was undertaken on a total of 56 peritonitis patients, 54 secondary to- perforation of the terminal ileum and 2 without grossly discernible Perforation, for the period of 18 months from May 1961 through October 1962, at the Department of Surgery, Kyungpook University Medical school Hospital, Taegu, Korea. In all cases the terminal ileum was resected and studied histopathologically. Upon completion of the investigation the following conclusions were drawn:
1. The diagnosis of typhoid fever were established for all 56 cases after bacteriological and histological investigation.
2. The age incidence in this series ranged from 4 to 55 with a peak distribution from 21 to 30 years (41.07%). The male to female ratio was 2 : 1.
3. In 83.93% a high fever was observed. The time needed to develop intestinal perforation was found to be 11?20 days in 37. 73%, 10 days (or less) in 33. 97% and 21?30 days in 24. 5%.
4. Leukopenia was observed in only 10..7% of the cases studied and in 50% the white cell count was within normal limits. Interestingly, leukocytosis was observed in 39.30%. In the majority of the cases the differential count showed an increase in neutrophils and a decrease in lymphocytes, monocytes, eosinophils and platlets.
5. In 9 out of 14 cases (64.28%) for which iliac crest marrow study was per formed, large hitherto unknown macrophages which were thought to be characteristic of typhoid fever (? typhoid cell) were observed.
6. The Widal test was positive, above 100 units in 25 out of 55 tested..: (45.45 %) when the tested patient sera was tested against them ixture of 0 & H antigen. S. typhosa D, was isolated in 13 patients out of 55 studied (23. 2%) and S. paratyphi A in one patient totalling 14 cases. The S. typhosa was isolated from the bile in 44. 4%, from the bone marrow in 21. 4% and from the stool in 11.3%.
7. Intestinal perforation was present in the ileum on the anti-mesenteric side in all cases, and in 61.97% the perforation was noted within 50 an. of the ileocecal valve. Practically´ all the perforations (97. 18%) were located within a distance of 100 cm. from the valve. In 81.48% the number of perforations was one per case The size of the ileal perforation averaged 0.5 cm. in its greatest dimension in 69 .01%. The shape of the perforation was oval in 70.42% followed by round to irregular in decreasing frequency. In the majority of the oval perforations the long axis paralleled the longitudinal axis of the intestine.
8. In 83. 68% of the 662 total ulcers examined, the shape of the ulcer fell in the so-called open eye form. Of the rest, 7. 25% were round and 3. 78% of the irregular form. The classic form was found in less than 5.29%.
9. Out of a total of 633 ulcers found in the resected ilei submitted for examination, it was observed that 77 ulcers were located within enlarged Peyer´s patches Among those ulcers located within the Peyer´s patches, 76 were of the "open eye" form and only 1 ulcer was observed to be classical in shape. Grossly recognizable hyperapisia of the Peyer´s patches numbered 38 cases (67. 88%) in a total of 56 specimens.
10. In 53. 02%, the largest dimension of the ulcel was less than I cm., and in 35, 64% it ranged from 1. 1 to 2. 0 cm. The greatest dimension of the ulcer with atypical form measured less than 2. 0cm. in the. majority of the cases.
11. The cases with perforation through an open eye ulcer were found to be the most common, followed by the typical, the round and the irregular ulcers in that order. In determining the perforation tendency of each type of ulcer however, the typical form showed the highest percent of perforation, followed by the round, the irregular and the open eye type in decreasing order.
12. Histologically, all of the 56 resected ilei revealed classical pictures of typhoid fever.
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